Heather Venkat1,2,3, Laura Adams2,4, Rebecca Sunenshine3,4, Elisabeth Krow-Lucal1,5, Craig Levy3, Tammy Kafenbaum3, Tammy Sylvester3, Kirk Smith6, John Townsend6, Melissa Dosmann7, Hany Kamel8, Roberto Patron7, Matthew Kuehnert9, Pallavi Annambhotla9, Sridhar V Basavaraju9, Ingrid B Rabe5. 1. Epidemic Intelligence Service Program, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia. 2. Arizona Department of Health Services, Phoenix, Arizona. 3. Maricopa County Department of Public Health, Phoenix, Arizona. 4. Office of Public Health Preparedness and Response, Career Epidemiology Field Officer Program, CDC, Atlanta, Georgia. 5. CDC Division of Vector-Borne Diseases, Fort Collins, Colorado. 6. Maricopa County Environmental Services Vector Control Division, Phoenix, Arizona. 7. Division of Infectious Diseases, Mayo Clinic, Phoenix, Arizona. 8. Blood Systems, Inc, Scottsdale, Arizona. 9. Division of Healthcare Quality Promotion, CDC, Atlanta, Georgia.
Abstract
BACKGROUND: St. Louis encephalitis virus is a mosquito-borne flavivirus that infrequently causes epidemic central nervous system infections. In the United States, blood donors are not screened for St. Louis encephalitis virus infection, and transmission through blood transfusion has not been reported. During September 2015, St. Louis encephalitis virus infection was confirmed in an Arizona kidney transplant recipient. An investigation was initiated to determine the infection source. STUDY DESIGN AND METHODS: The patient was interviewed, and medical records were reviewed. To determine the likelihood of mosquito-borne infection, mosquito surveillance data collected at patient and blood donor residences in timeframes consistent with their possible exposure periods were reviewed. To investigate other routes of exposure, organ and blood donor and recipient specimens were obtained and tested for evidence of St. Louis encephalitis virus infection. RESULTS: The patient presented with symptoms of central nervous system infection. Recent St. Louis encephalitis virus infection was serologically confirmed. The organ donor and three other organ recipients showed no laboratory or clinical evidence of St. Louis encephalitis virus infection. Among four donors of blood products received by the patient via transfusion, one donor had a serologically confirmed, recent St. Louis encephalitis virus infection. Exposure to an infected mosquito was unlikely based on the patient's minimal outdoor exposure. In addition, no St. Louis encephalitis virus-infected mosquito pools were identified around the patient's residence. CONCLUSION: This investigation provides evidence of the first reported possible case of St. Louis encephalitis virus transmission through blood product transfusion. Health care providers and public health professionals should maintain heightened awareness for St. Louis encephalitis virus transmission through blood transfusion in settings where outbreaks are identified.
BACKGROUND:St. Louis encephalitis virus is a mosquito-borne flavivirus that infrequently causes epidemic central nervous system infections. In the United States, blood donors are not screened for St. Louis encephalitis virus infection, and transmission through blood transfusion has not been reported. During September 2015, St. Louis encephalitis virus infection was confirmed in an Arizona kidney transplant recipient. An investigation was initiated to determine the infection source. STUDY DESIGN AND METHODS: The patient was interviewed, and medical records were reviewed. To determine the likelihood of mosquito-borne infection, mosquito surveillance data collected at patient and blood donor residences in timeframes consistent with their possible exposure periods were reviewed. To investigate other routes of exposure, organ and blood donor and recipient specimens were obtained and tested for evidence of St. Louis encephalitis virus infection. RESULTS: The patient presented with symptoms of central nervous system infection. Recent St. Louis encephalitis virus infection was serologically confirmed. The organ donor and three other organ recipients showed no laboratory or clinical evidence of St. Louis encephalitis virus infection. Among four donors of blood products received by the patient via transfusion, one donor had a serologically confirmed, recent St. Louis encephalitis virus infection. Exposure to an infected mosquito was unlikely based on the patient's minimal outdoor exposure. In addition, no St. Louis encephalitis virus-infected mosquito pools were identified around the patient's residence. CONCLUSION: This investigation provides evidence of the first reported possible case of St. Louis encephalitis virus transmission through blood product transfusion. Health care providers and public health professionals should maintain heightened awareness for St. Louis encephalitis virus transmission through blood transfusion in settings where outbreaks are identified.
Authors: Iara J F Motta; Bryan R Spencer; Suely G Cordeiro da Silva; Monica B Arruda; Jane A Dobbin; Yung B M Gonzaga; Ingrid P Arcuri; Rita C B S Tavares; Elias H Atta; Regina F M Fernandes; Deise A Costa; Liane J Ribeiro; Fabio Limonte; Luiza M Higa; Carolina M Voloch; Rodrigo M Brindeiro; Amilcar Tanuri; Orlando C Ferreira Journal: N Engl J Med Date: 2016-08-17 Impact factor: 91.245
Authors: R G McLean; J P Webb; E G Campos; J Gruwell; D B Francy; D Womeldorf; C M Myers; T H Work; M Jozan Journal: J Am Mosq Control Assoc Date: 1988-12 Impact factor: 0.917
Authors: Stephanie M Pouch; Shalika B Katugaha; Wun-Ju Shieh; Pallavi Annambhotla; William L Walker; Sridhar V Basavaraju; Jefferson Jones; Thanhthao Huynh; Sarah Reagan-Steiner; Julu Bhatnagar; Kacie Grimm; Susan L Stramer; Julie Gabel; G Marshall Lyon; Aneesh K Mehta; Prem Kandiah; David C Neujahr; Jeffrey Javidfar; Ram M Subramanian; Samir M Parekh; Palak Shah; Lauren Cooper; Mitchell A Psotka; Rachel Radcliffe; Carl Williams; Sherif R Zaki; J Erin Staples; Marc Fischer; Amanda J Panella; Robert S Lanciotti; Janeen J Laven; Olga Kosoy; Ingrid B Rabe; Carolyn V Gould Journal: Clin Infect Dis Date: 2019-07-18 Impact factor: 9.079